Does the quality of safetalk motivational interviewing counseling predict sexual behavior outcomes among people living with HIV?
Catherine Grodensky, Carol Golin, Megha A Parikh and 8 others
PMID 27567497WHAT IT FOUND
For people living with HIV in SafeTalk, coded MI sessions with higher counselor acceptance, empathy, MI spirit, client self-exploration, and reflection-to-question ratios were associated with fewer condomless sex acts.
Client-rated quality did not track coded quality and had mixed associations.
Key findings
01Higher MISC-2.0 global ratings of counselor acceptance, empathy, MI spirit, and client self-exploration, plus a higher reflection-to-question ratio, were associated with fewer condomless anal or vaginal sex acts at 8 months.
02For each one-unit increase in MISC-2.0 quality, the rate of condomless anal or vaginal intercourse decreased by 46% for counselor acceptance, 53% for MI spirit, 33% for client self-exploration, and 90% for the reflection-to-question ratio.
03Client ratings did not correlate significantly with coded global ratings; higher client-rated counselor acceptance, disclosure, and relevance were associated with more condomless sex acts, while higher perceived benefit was associated with fewer.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This analysis used only the SafeTalk intervention arm, so it cannot compare with the control arm or separate the effect of counseling from the audio and printed materials and booster letters. Only one coded session was reviewed per randomly selected participant, although most participants received four sessions. The MISC-coded sample was small, with 32 participants. The outcome was condomless sex with any partner, not specifically with at-risk partners, so it does not directly address HIV transmission risk or newer prevention options. The client exit survey was developed for this study and was not validated, and one large sexual behavior count may have reduced precision. The coded quality analysis used an older MISC version, and the newer version was not available.
Declared interests
The supplied metadata lists NIH extramural research support. No author conflicts of interest statement is provided.
The easy way to misread this
Do not read the coded-quality associations as proof that MI counseling alone caused fewer condomless sex acts. SafeTalk also included audio and printed materials and booster letters, and this analysis was only within the intervention arm, so the contribution of any single component cannot be separated.